Scared and troubled over my health, I would take ten to twelve pills a day. Those were the old days of desolation, circa 2006, when I had just learnt that I had abdominal TB. Today I am a healthy and confident woman living with HIV, who is a survivor of TB.
Unfortunately, not all have been so lucky. With more than 1,400 persons dying every day due to TB, the epidemic kills an estimated 4,80,000 Indians every year. India has the second largest number of tuberculosis cases per year; with more than a quarter of HIV deaths in the country occurring among patients co-infected with TB. One of the main reasons for this horrific data is that, India has more than a million ‘missing’ TB cases every year… cases that are not identified or notified. They either remain undiagnosed or unaccounted, or/and cases that were inappropriately diagnosed and treated, mostly in the private sector.
Thinking back to those days of innumerable medicines and my failing health, it is remarkable that in eleven years so much has changed in terms of TB diagnosis, treatment and care. Earlier, there was list of complaint that being a TB positive person living with HIV would have to go to the nearest DOTs (direct observed therapy) centre facing fear of HIV status disclosure among the local population. There were also a large volume of pills that had to be taken, which were available at DOT services provider in only Designated Microscopy Centres (DMC). Not only that, but many of these pills had also to be taken empty stomach resulting in nausea and vomit.
Since then, the Government has introduced a series of measures to strengthen the HIV-TB response in India. It is noteworthy that the Indian Government has updated its TB testing facilities for people living with HIV (PLHIV), and now treatment for TB is easily available at ART centres. Foremost, a one-month take-home medication course is found at all ART centres; this has strengthened the TB response as PLHIV do not have to travel long distances for DOT centres, and there is no fear of disclosure among them while undergoing TB treatment. Also, the daily medication for TB as given at ART centres are of good quality with less side effects. Another noteworthy decision was when in 2016, on the occasion of World AIDS Day, the Honorable Health Minister, Mr. J.P. Nadda, announced free availability of Iconized Preventive Therapy for all PLHIV who are TB negative to ensure prevention of TB. On similar lines, as per the National Strategic Plan 2012–17 of RNTCP (Revised National Tuberculosis Control Program), 601 CBNAAT (Cartridge Based Nucleic Acid Amplification Test) centres were established at district hospitals, including all ART centres and centres of excellence of pediatric ART centre across the country. This groundbreaking move enabled early diagnosis and treatment of active TB patients within the ART centres, and ensured easy accessibility to treatment facilities for all PLHIV.
Complementing the government programme is Vihaan Care and Support program, wherein we are screening all registered PLHIV for TB, and those who are screened positive are linked to the ART centres for diagnosis through CBNAAT, and follow-up treatments are then initiated. Keeping in mind that timely investigation and preventive medication is essential, regular monitoring of TB positive PLHIV, along with their families, are also done. From January 2016 to December 2017, total of 782,108 registered PLHIV were screened for TB by CSC outreach team members, of which 8,503 were found positive and linked with diagnosis, treatment and care services. This is definitely one India’s most fruitful “Unite to end TB” endeavor.
Recently, as we observe the World TB Day, I, as a part of the PLHIV community, want to thank the government of India, especially the Central TB division, for its support in enabling people like me to live a life of wellbeing. The support shown by the division and the government has made much needed treatment available and accessible, thus strengthening the rights to health for all TB positive PLHIV. The tremendous work as done by the government is an inspiration for all of us in continuing our work in uniting to end TB.
Mona Balani, Programme Officer: Vihaan Care & Support, is the author of this blog.
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